Background Kaiser Permanente (KP) is America’s largest non-profit health plan and integrated healthcare delivery system serving nearly 10 million members across 8 states. Historically, KP has lacked a systematic approach to advance care planning (ACP).

Aim KP’s Care Management Institute (CMI) serves to support identification and spread of national best practice. CMI is supporting widespread adoption of a proven, systematic approach to ACP across all KP regions.

Methods In late 2013, KP Northern California commenced implementation of an evidence-based approach to ACP. CMI has since supported interregional spread by negotiating national training contracts, educating and engaging cross-regional leadership, coordinating interregional sharing and metrics, and constructing a best-practice implementation guide.

Results Three of KP’s seven regions (serving 85% of all membership) have initiated implementation of systematic ACP. A fourth will start in 2016. Regions not yet participating cite insufficient resources and staff, and competing priorities. As of 1/2015, the organisation has trained 850 facilitators who have completed nearly 14,000 conversations. Early outcomes include high concordance between member wishes and care delivered.

Discussion CMI and regional ACP leaders identify five key success factors for adoption and spread: upfront investment in critical infrastructure; organisation-wide inspiration of top-to-bottom stakeholders; proactive team engagement and support; elimination of barriers and silos; and incorporation of continuous quality improvement.

Conclusion National adoption of an evidence-based, systematic ACP in a large integrated health system appears feasible. Speed of adoption and spread depend on organisational will to invest in critical infrastructure and a top-to-bottom, sustained commitment to change.